Drugs & Aging最新文献

{"title":"Sarcopenia and Cachexia in Older Patients with Cancer: Pathophysiology, Diagnosis, Impact on Outcomes, and Management Strategies.","authors":"Efthymios Papadopoulos, Brian A Irving, Justin C Brown, Steven B Heymsfield, Schroder Sattar, Shabbir M H Alibhai, Grant R Williams, Richard F Dunne","doi":"10.1007/s40266-025-01252-y","DOIUrl":"https://doi.org/10.1007/s40266-025-01252-y","url":null,"abstract":"<p><p>Sarcopenia and cachexia are two common and overlapping but distinct muscle wasting syndromes that predict adverse outcomes and undermine quality of life among older adults with cancer. Despite their prognostic value and negative effects on older patients' well-being, sarcopenia and cachexia are not routinely or adequately assessed and managed in clinical oncology practice. However, efforts to recognize and manage sarcopenia and cachexia at diagnosis and during follow-up may have beneficial effects on muscle mass, physical function, and quality of life among older adults with cancer, although evidence on long-term clinical outcomes in response to targeted interventions has yet to be established. This comprehensive review attempts to (i) delineate the differences in the pathophysiology and clinical manifestations between sarcopenia and cachexia, (ii) clarify how sarcopenia and cachexia are defined in the geriatric oncology literature, (iii) describe methods for assessing sarcopenia and cachexia in clinical practice, (iv) review the prognostic value of sarcopenia and cachexia among older patients, particularly those undergoing systemic cancer treatment, and (v) discuss evidence-based strategies aimed at managing sarcopenia and cachexia for older adults with cancer.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyloid-related Imaging Abnormalities (ARIA) in the Context of Alzheimer's Disease and Amyloid-targeting Therapies: An Introduction for Advanced Practice Providers.","authors":"Curtis P Schreiber, Amy Kovacik, James Bishop, Jon Helman","doi":"10.1007/s40266-025-01253-x","DOIUrl":"https://doi.org/10.1007/s40266-025-01253-x","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is a progressive neurodegenerative disorder pathologically characterized by the accumulation of amyloid-beta (Aβ) and neurofibrillary tangles of hyperphosphorylated tau in the brain. Amyloid-targeting therapies (ATTs) are the first available disease-modifying treatments shown to slow cognitive and functional decline for patients with mild cognitive impairment owing to AD and early symptomatic AD. Currently two ATTs are commercially available, donanemab (Kisunla™) and lecanemab (Leqembi^®). The main potential side effect and safety concern of ATT treatment is amyloid-related imaging abnormalities (ARIA). ARIA can be categorized into two types that can co-occur: ARIA-E (edema/sulcal effusion) and ARIA-H (hemorrhage/superficial siderosis). Although both are often asymptomatic and ARIA-E typically resolves radiographically over time, both forms can be radiologically and/or clinically serious. Treating clinicians should be equipped with a comprehensive understanding of ARIA. This review aims to provide advanced practice providers, who are pivotal to patient care in AD, with critical insights into ARIA to safely identify risk factors, understand treatment guidelines, and gain familiarity with appropriate management strategies. It emphasizes the importance of understanding APOE genotype and vascular factors in ARIA risk and recognizing the clinical and radiographic manifestations of ARIA. Practical recommendations are provided for monitoring and managing ARIA, including dose management strategies and education on symptom awareness. By fostering a comprehensive understanding of ARIA and its monitoring and management, this review aims to support the safe and effective implementation of ATTs, contributing to optimized patient care for those treated with ATTs.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention.","authors":"Shuai Zhao, Boda Zhu, Yan Chen, Tiantong Yu, Bohui Zhang, Xi Zhang, Peng Han, Youhu Chen, Genrui Chen, Li Yang, Zhijun Tan, Gang Wang, Sida Jin, Yi Yang, Rutao Wang, Chengxiang Li, Kun Lian","doi":"10.1007/s40266-025-01235-z","DOIUrl":"10.1007/s40266-025-01235-z","url":null,"abstract":"<p><strong>Purpose: </strong>Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) after successful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.</p><p><strong>Methods: </strong>Consecutive patients who underwent successful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.</p><p><strong>Results: </strong>A total of 701 patients who underwent successful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).</p><p><strong>Conclusions: </strong>Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in CTO-PCI patients.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"975-985"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of NSAIDs on Early CKD Development: A 10-Year Population-Based Study Using the Korean Senior Cohort.","authors":"Jung-Sun Lim, Sujeong Han, Jong Seung Kim, Sunyoung Kim, Bumjo Oh","doi":"10.1007/s40266-025-01239-9","DOIUrl":"10.1007/s40266-025-01239-9","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management but are associated with nephrotoxicity, particularly in senior populations. While the acute nephrotoxicity of NSAIDs is well established, evidence on their long-term effects on renal function-particularly in community-dwelling older adults-has been mixed across studies.</p><p><strong>Objectives: </strong>This study investigated the association between NSAID use and chronic kidney disease (CKD) risk in the general senior population.</p><p><strong>Methods: </strong>Data from the National Health Insurance Service-Senior Cohort (NHIS-SC) in South Korea were analyzed, including 1812 participants (604 NSAID users and 1208 controls) matched 1:2 by propensity score. Kidney dysfunction was defined as glomerular filtration rate (eGFR) < 60 mL/min/1.73m² with a ≥ 10% decline from baseline. Hazard ratios (HRs) for CKD were estimated using Cox regression.</p><p><strong>Results: </strong>NSAID use was associated with an increased CKD risk (HR 1.46; 95% confidence interval (CI) 1.11-1.93) and faster eGFR decline. Subgroup analysis showed elevated risks for Cox-1 (HR 1.53) and Cox-2 inhibitors (HR 1.61). End-stage renal disease (ESRD) incidence was rare and not significant.</p><p><strong>Conclusions: </strong>NSAIDs increase CKD risk and accelerate kidney function decline in senior individuals. Cautious prescription and regular kidney monitoring are recommended, and further randomized trials are needed.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"953-961"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basal Insulin and GLP-1 Receptor Agonist Combination Therapy in Frail Older Inpatients: A Real-World Observational Study.","authors":"Filippo Niccolai, Chukwuma Okoye, Alessandro Mengozzi, Tessa Mazzarone, Ludovica Di Carlo, Valeria Calsolaro, Agostino Virdis","doi":"10.1007/s40266-025-01241-1","DOIUrl":"10.1007/s40266-025-01241-1","url":null,"abstract":"","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"987-989"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/Valsartan Reduces the Risk of All-Cause Dementia in Patients with Heart Failure: A Systematic Review and Meta-Analysis.","authors":"Mohamed Mohsen Helal, Nereen A Almosilhy, Nada G Hamam, Mohamed Ahmed Adel Abdelbaset, Ali Nagy Shelbaya, Halima Abdirashid Y Musse, Aishwarya Prasad","doi":"10.1007/s40266-025-01233-1","DOIUrl":"10.1007/s40266-025-01233-1","url":null,"abstract":"<p><strong>Background: </strong>Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has become a cornerstone therapy for heart failure (HF) since its approval over a decade ago. However, concerns have emerged about potential cognitive risks, as neprilysin inhibition may contribute to the accumulation of amyloid-beta (Aβ) in the brain-a hallmark of Alzheimer's disease, the most common form of dementia.</p><p><strong>Objective: </strong>Given the already elevated risk of dementia in patients with HF and the widespread use of sacubitril/valsartan, this meta-analysis aimed to evaluate whether its use is associated with an increased risk of all-cause dementia in HF populations.</p><p><strong>Methods: </strong>A systematic literature search was conducted on 23 March 2025, to identify eligible studies comparing the risk of dementia in patients receiving sacubitril/valsartan versus those receiving placebo, no treatment, or other HF medications. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model.</p><p><strong>Results: </strong>Six studies, comprising 101,074 participants and published between 2017 and 2024, were included in the meta-analysis. Treatment with sacubitril/valsartan was associated with a significant 15% reduction in the risk of all-cause dementia (RR = 0.85; 95% CI: 0.74-0.98; p = 0.02). Leave-one-out sensitivity and subgroup analyses confirmed the robustness of the findings.</p><p><strong>Conclusions: </strong>This meta-analysis suggests that sacubitril/valsartan is associated with a reduced risk of dementia in patients with HF, helping to alleviate previous concerns about potential cognitive adverse effects. These findings support the continued use of sacubitril/valsartan as a foundational therapy in this high-risk population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"907-920"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoglycaemia in Older Adults with Diabetes: Pathophysiology, Prevention, and Personalized Care in an Aging Population.","authors":"Virginia Boccardi, Alan J Sinclair","doi":"10.1007/s40266-025-01236-y","DOIUrl":"10.1007/s40266-025-01236-y","url":null,"abstract":"<p><p>Managing diabetes in older adults requires balancing long-term glycaemic control with the prevention of hypoglycaemia, to which this population is particularly vulnerable owing to frailty, multimorbidity and cognitive decline. Guidelines recommend individualized glucose targets for older adults, particularly those with multimorbidity or increased hypoglycaemia risk. For individuals with frailty or cognitive impairment, relaxed HbA1c targets are often appropriate to reduce the risk of adverse events. While HbA1c is widely used, it has important limitations in this population due to its inability to reflect daily glucose fluctuations. Continuous glucose monitoring (CGM) or self-monitoring of blood glucose provide more granular data to guide therapy. This review explores the pathophysiology, complications, and management of hypoglycaemia in older adults, emphasizing individualized care, safer pharmacotherapies (e.g. DPP-4 inhibitors, GLP-1 receptor agonists, ultra-long-acting insulins), and emerging technologies (continuous glucose monitoring, artificial Intelligence-guided insulin delivery and telehealth).</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"921-932"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting IL-6 Signaling: Safety and Effectiveness in Older Patients with Rheumatoid Arthritis.","authors":"Hideto Kameda, Reina Maezawa, Yasuto Minegishi, Chihiro Imaizumi, Takaharu Katagiri, Takehisa Ogura","doi":"10.1007/s40266-025-01248-8","DOIUrl":"10.1007/s40266-025-01248-8","url":null,"abstract":"<p><p>Interleukin (IL)-6 plays a central role in amplifying inflammation, and its inhibition is beneficial in managing immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA). IL-6 signaling inhibition is associated with a slightly increased risk of infections in patients with RA, and older age has been identified as a risk factor for severe adverse events, including infections. Therefore, the combination of an aging population and the increasing use of IL-6R inhibitors in RA treatment highlights the importance of carefully evaluating the safety and effectiveness of these therapies in older patients with RA. Recent postmarketing surveillance (PMS) data on the safety and effectiveness of sarilumab (SAR) in Japanese patients with RA, along with PMS data from Japan and registry data from France and Germany of tocilizumab (TCZ), provide valuable insights for both current and future management of RA. These data suggest that anti-IL-6R therapies are generally well tolerated among older patients with RA and do not appear to increase the risk of cardiovascular events or malignancies. While the effectiveness of TCZ was somewhat lower in older patients compared with younger ones, the effectiveness of SAR was similar across age groups. Consequently, the use of anti-IL-6R antibodies is anticipated to expand to other IMIDs beyond RA, particularly in increasingly superaged societies worldwide.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"945-951"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Medication Dispensation Data to Identify Clusters with Similar Prescribing Patterns in Older Adults Living with Dementia.","authors":"Abby Emdin, Therese A Stukel, Jennifer Bethell, Xuesong Wang, Andrea Iaboni, Susan E Bronskill","doi":"10.1007/s40266-025-01228-y","DOIUrl":"10.1007/s40266-025-01228-y","url":null,"abstract":"<p><strong>Background and objectives: </strong>Older adults living with dementia are a heterogeneous group, which can make studying optimal medication management challenging. Unsupervised machine learning is a group of computing methods that rely on unlabeled data-that is, where the algorithm itself is discovering patterns without the need for researchers to label the data with a known outcome. These methods may help us to better understand complex prescribing patterns in this population. The objective of our study was to use clustering methods to determine whether common prescribing clusters exist in older adults newly identified as living with dementia in Ontario, Canada and to examine the association between individual clinical and demographic characteristics and those clusters.</p><p><strong>Methods: </strong>Data were derived from population-based health administrative databases, including medication dispensation data. The hierarchical clustering algorithm started with each individual and merged individuals with the most similar prescribing patterns into a group, continuing this process stepwise until only one cluster remained. The optimal number of clusters was selected through clinical review and fit statistics. We examined the association between individual characteristics and prescribing clusters using bivariate multinomial models.</p><p><strong>Results: </strong>In 99,046 individuals living with new dementia, we identified six prevalent clusters of individuals with common medication subclass patterns: higher dispensation of angiotensin-converting enzyme-specific cardiovascular (22.6% of the population), central nervous system-active (21.3%), hypothyroidism (22.9%), respiratory (3.9%), and angiotensin receptor blocker-specific cardiovascular (6.1%), as well as a group with lower dispensation of medications in general (23.1%). Specific demographic, clinical, and health-service-use characteristics were associated with assigned clusters.</p><p><strong>Conclusions: </strong>Within individuals living with dementia, prescribing clusters reflected meaningful differences in clinical and demographic characteristics. The results suggest that applying clustering methods to pharmacological data may be useful in estimating complex comorbidity patterns to better describe a heterogeneous population of people living with dementia. Future studies could examine whether these clusters better predict health service use, disease progression, or medication-related adverse events compared with other measures.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"963-974"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/Valsartan, Heart Failure and Risk of Dementia.","authors":"Antoine Garnier-Crussard, Virginie Dauphinot, Christelle Mouchoux, Teddy Novais","doi":"10.1007/s40266-025-01242-0","DOIUrl":"10.1007/s40266-025-01242-0","url":null,"abstract":"","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"903-905"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}